RESUMO
It is known that anti-TNFα therapy has opened a new era in treatment of rheumatoid arthritis, and it is emerging as a new successful treatment in the current rheumatologic practice. Besides, there is evidence that this therapy is an important cause of iatrogenic autoimmune disease. Several studies reported the possible onset of lupus syndrome that can be resolved with withdrawal of anti-TNFα drugs. Our report describes the first lupus nephritis case developing in a rapidly progressive renal failure that required haemodialysis treatment in a patient affected with rheumatoid arthritis, treated with anti-TNFα therapy. So, we confirm the importance of a careful clinic and immunologic evaluation before starting anti-TNFα therapy.
RESUMO
Epidermolysis bullosa (EB) consists of a group of dominant or recessive autosomal diseases characterised by skin and mucosa fragility. The lesions leave erosions and scars that, in turn, can cause stenosis of tracheal, oesophageal, and genitourinary tract mucosae. The significantly increased survival of EB patients has determined the onset of complications never observed before, including genitourinary disorders such as hydroureteronephrosis, recurrent urinary tract infections, renal amyloidosis, IgA nephropathy and post-infectious glomerulonephritis. A 6-year-old boy diagnosed with recessive dystrophic EB Hallopeau-Siemens type (RDEB-HS) was referred to our clinic because of microhaematuria that evolved into intra-infectious macrohaematuria. Renal biopsy revealed an increase in both extracellular matrix and mesangial cells, with a focal segmental glomerulosclerosis with severe chronic tubulointerstitial damage. Immunofluorescence showed IgA mesangium deposits. Five years later, he was started on haemodialysis, because of worsening renal function. This is a rare case of a child with EB who was successfully treated with haemodialysis. The pertinent literature has been reviewed.